Pancreas Flashcards
Physical examination in pancreatic disease
- Position against pain- ‘lean on all four’
- Cullen,
- Grey-Turner signs- in severe acute cases
- skin nodules- occasionally, due to fat necrosis (extensor skin surfaces)
- Rarely- retinopathy- temp/perm.blindness in severe acute cases igns of malnutrition- in chronic cases fever
Acute pancreatitis etiology
I= idiopathic
G= gallstone
E=ethanol
T= trauma
S= steroids
M= mumps (infections)
A=autoimmune dis.
S= scorpion sting (toxins) H= hypercalcemia, hypertriglycerides
E= endoscopic colangiography
D= drugs
Manifestation in acute pancreatitis
- – Pain: upper abd-epigastric, severe, steady, radiating to back
- The duration of pain varies but typically lasts >24hs
- Nausea, vomiting, diarrhoea, loss of appetite –
- Systemic manif: sev form
- -dyspnea- pleural eff., acute respiratory distress sdr.
- Tenderness at the palpation of epigatsrium; guarding; often ileus
- Severe cases: hemodynamic instability
- Grey-Turner, Cullen: hemorrhagic form
- Rare- jaundice Muscle spasms- sec.to hypocalcemia
Acute pancreatitis colementary examination
– Enzymes: elevated levels of amylase, lipase, at least 3 times above the reference range erum lipase rises 4 to 8 hours from the onset of symptoms and normalizes within 1-2 weeks after treatment. Amylase: increases also in salivary gland diseases, Imaging tests macroamylasemia The levels don’t correlate with the severity
Forms of acute pancreatitis
– Mild- localized manifestations
– Severe- necrosis- followed by
systemic inflam.response
- Resp.changes: pleural effusion, dyspnea- irritation of the diaphragm, acute respiratory distress syndrome
- hemodynamic instability
- Cullen, Grey signs
Ransom criteria
Criteria present on admission : -patient older than 55 years -WBC count higher than 16,000/µL -Blood glucose level higher than 200 mg/dL -Serum L H level higher than 350 IU/L -A T level higher than 250 IU/L Criteria developing during the first 48 hours : -Hematocrit fall more than 10% -BUN level increased by more than 8 mg/dL -Serum calcium level lower than 8 mg/dL -Pa o2 less than 60 mm Hg -Base deficit higher than 4 mEq/L -Estimated fluid sequestration higher than 600 mL
Ranson score
Each of the above criteria counts for 1 point. A Ranson score of 0-2 has a minimal mortality A Ranson score of 3-5 has a 10-20% mortality rate, and the patient should be admitted to the intensive care unit A Ranson score higher than 5 after 48 hours has a mortality of more than 50% and is associated with more systemic complications.
Complication acute pancreatitis
- By definition, peripancreatic fluid collections persisting for more than 4 weeks are termed acute pseudocysts Infected pancreatic necrosis
- Abscess
- pancreatic duct disruption
Etiology of chronic pancreatitis
- Alcohol abuse
- ! Obstruction: congenital abnormalities (pancreas divisum) and acquired forms (trauma – trauma and ductal strictures) Hypercalcemia Hyperlipidemia
- Tropical pancreatitis
- autoimmune
- Inherited disorders: pancreatic secretory serine protease inhibitor mutation gene (ad); cystic fibrosis
- Idiopathic: 30% of cases
Clinical manifestation in chronic pancreatitis
- Pain: chronic pain/ intermittent ’attack” - pain severity either decreases or resolves over 5-25 years
- . steatorrhea (caused by fat malabsorption, resulting in bulky, foul-smelling stools that may appear oily and float)
- *Weight loss**
- diabetes- 10 years >90% of the pancreas is destroyed maldigestion (due to decreased intraluminal hydrolysis of food)
- Signs of manutrition
- During attack”: flexion of the knees
- Possible mass in the epigastrium - palpation
Diabetics mellitus type 1
Type 1= circulating insulin is very low or absent, plasma glucagon is elevated, and the pancreatic beta cells fail to respond to all insulin-secretory stimuli. – Autoimmunity – Usually up to age of 40 – strong genetic component
Diabetes type 2
Type 2 = peripheral insulin resistance with an insulin-secretory defect
– Maturity-onset diabetes of the young (M Y) is a form of type 2 diabetes that affects many generations in the same family with an onset in individuals younger than 25 years.
Risk factor of diabetes mellitus type2
- Age - older than 45 years
- Obesity
- Family history of type 2 diabetes in a first-degree relative
- Hispanic, Native American, African American, Asian American, or acific Islander descent History of previous impaired glucose tolerance (IGT) or impaired fasting glucose (I G)
- Hypertension (>140/90 mm Hg) or dyslipidemia
- History of delivering a baby with a birth weight of >4kg
- Polycystic ovarian syndrome (which results in insulin resistance)
Who diabetes criteria
Diabetes
- Fasting plasma glucose ≥7.0mmol/l (126mg/dl) or 2-h
- plasma glucose ≥11.1mmol/l (200mg/dl)
Impaired Glucose tolerance (IGt)
- Fasting plasma glucose n<7.0mmol/l (126mg/dl)
- 2–h plasma glucose ≥7.8 and <11.1mmol/l (between 140mg/dl and 200mg/dl)
Impaired fasting Glucose (IfG)
- Fasting plasma glucose 6.1 to 6.9mmol/l (110mg/dl to 125mg/dl)
- 2–h plasma glucose and (if measured) <7.8mmol/l (140mg/dl)
manifestation of diabetes
-PPPGBFMN
- Polyuria and thirst: olyuria is due to osmotic diuresis secondary to hyperglycemia. Thirst is due to the hyperosmolar state and dehydration.
- Polyphagia with weight loss: The weight loss with a normal or increased appetite is due to depletion of water and a catabolic state
-
Gastrointestinal symptoms: Nausea, abdominal discomfort or pain- in ketoacidosis
– Chronic gastrointestinal symptoms in the later stage of diabetes are due to visceral autonomic neuropathy. - -Peripheral neuropathy: numbness and tingling in hands and feet, in a glove and stocking pattern. It is bilateral, symmetric, and ascending neuropathy, which results from many factors, including the accumulation of sorbitol in peripheral sensory nerves due to sustained hyperglycemia. -
- beta cell destruction may have started months or years before the onset of clinical symptoms.
- -fatigue and weakness: due to a catabolic state of insulin deficiency, hypovolemia, and hypokalemia. -
- Muscle cramps: This is due to electrolyte imbalance.
- -Nocturnal enuresis: secondary to polyuria; can be an indication of onset of diabetes in young children.
- -Blurred vision: due to the effect of the hyperosmolar state on the lens and vitreous humor.
